Pulmonary sporotrichosis in the absence of lymphocutaneous disease is unusual; however, its incidence may be greater than previously recognized. This report describes the AFIP experience in eight cases of primary pulmonary sporotrichosis and reviews an additional 23 cases. The disease is often a bilateral, apical, chronic and cavitary, progressive, destructive, and debilitating infection, most often seen in middle-aged men with a history of alcoholism and chronic obstructive pulmonary disease. In this clinical setting, pulmonary sporotrichosis closely mimics tuberculosis or histoplasmosis. However, this clinical charade can be unmasked by serologic tests, cultures, and identification of the causative agent, Sporothrix schenckii, in sections of paraffinembedded lung containing necrotizing granulomas and stained with periodic acid-Schiff and Gomori methenamine- silver nitrate. Previously not recognized is the presentation of primary pulmonary sporotrichosis as a solitary, peripheral, necrotizing pulmonary nodule, observed in two patients. Chronic cavitary pulmonary sporotrichosis is usually refractory to drug therapy; however, when combined with surgical resection, cure can be attained.
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